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Uterine (Endometrial) Cancer

cancer uterus


Most cases of uterine cancer (cancer of the uterus or womb) arise from the inside lining of the uterus (the endometrium). This is called endometrial cancer. The most common early symptom is abnormal vaginal bleeding.

Most uterine cancers develop from cells in the endometrium (endometrial cancer). The rest of this leaflet deals only with endometrial cancer of the uterus.

Endometrial cancer

Type and grade of endometrial cancer

Most cases of endometrial cancer are called endometrioid adenocarcinomas. looking at certain features of the cells the cancer can be graded.

Grade 1 (low grade) - The cancer cells are The cancer cells tend to grow and multiply quite slowly and are not so aggressive.
Grade 2 - is a middle grade.
Grade 3 - grow and multiply quite quickly and are more aggressive.

What causes endometrial cancer?

The exact reason why a cell becomes cancerous is unclear. There are risk factors which are known to increase the risk of endometrial cancer developing. These include the following:

Increased exposure to oestrogen.Oestrogen is the main female hormone. It is thought that factors which lead to prolonged higher than usual levels of oestrogen, or increased levels of oestrogen not being balanced by progesterone, may somehow increase the risk of endometrial cells becoming cancerous. These include:

If you have never had a baby. This is because your womb has never had a rest from the rise of oestrogen that happens in the course of a normal monthly cycle.
If you are overweight or obese. This is because fat cells make a certain amount of oestrogen.
If you have certain rare oestrogen-producing tumours.
If you have a late menopause (after the age of 52) or started periods at a young age. This is because you will have more monthly menstrual cycles.

Endometrial hyperplasia. This is a benign (non-cancerous) condition where the endometrium builds up more than usual. Most women with this condition do not develop cancer, but the risk is slightly increased.

Tamoxifen. This is a drug which is used in the treatment of breast cancer. The risk of developing endometrial cancer from tamoxifen is very small and the benefits of taking tamoxifen usually outweigh the risks.

Diabetes. There is a small increased risk in women with diabetes.

Polycystic ovary syndrome. There is a very slight increased risk in women with this condition.

Diet. There are much fewer cases of endometrial cancer in certain eastern countries and dietary factors may be the reason. A western diet high in fat may be a contributing factor.

Genetic factors. Most cases are not due to genetic or hereditary factors. However, in a small number of cases, a faulty gene (which can be inherited) may trigger the disease. This disorder is called hereditary nonpolyposis colon cancer (HNPCC).

Women who take the combined oral contraceptive pill have a lower risk of developing endometrial cancer.

What are the symptoms of endometrial cancer?

In most cases the first symptom to develop is abnormal vaginal bleeding such as:

Vaginal bleeding past the menopause. This can range from spotting to more heavy bleeds. This is the most common symptom of endometrial cancer.
Bleeding after having sex .
Bleeding between normal periods, in women who have not gone through the menopause.
Early symptoms that occur in some cases are: pain during or after having sex, vaginal discharge, and pain in the lower abdomen.All of the above symptoms can be caused by various other common conditions. However, if you develop any of these symptoms, you should see your doctor.
In time, if the cancer spreads to other parts of the body, various other symptoms can develop.

How is endometrial cancer diagnosed and assessed?

To confirm the diagnosis

A doctor will usually do a vaginal examination if you have symptoms which may be due to endometrial cancer. He or she may feel an enlarged uterus. It is likely you will need to have a further test to confirm the diagnosis - usually one of the following:

Ultrasound scan of the uterus.. The probe of the scanner may be placed on your abdomen to scan the womb. Sometimes a small probe is also placed inside the vagina to scan the uterus from this angle.

Endometrial biopsyThis is where a thin tube is passed into the uterus. Samples of the endometrium are obtainedusing very gentle suction. This is done in the outpatient clinic, without an anaesthetic. The sample is looked at under the microscope to look for any abnormal cancer cells


Hysteroscopy. This is where a doctor uses a hysteroscope, which is a thin telescope that is passed through the cervix into the uterus. The doctor can see the lining of the uterus and take biopsies. This can also be done without an anaesthetic.

Assessing the extent and spread

If endometrial cancer is confirmed then further tests may be advised to assess if the cancer has spread. For example, a CT scan, an MRI scan, a chest X-ray, blood tests, an examination under anaesthetic of the uterus, bladder or rectum, or other tests. This assessment is called staging of the cancer. The aim of staging is to find out:
How much the tumour has grown, and whether it has grown to other nearby structures such as the cervix, bladder or rectum.

Whether the cancer has spread to local lymph glands (nodes).

Whether the cancer has spread to other areas of the body (metastasised).

Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for endometrial cancer?

Surgery is the main treatment for endometrial cancer. Radiotherapy or chemotherapy are also used in some circumstances. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread) and your general health.

Surgery

An operation to remove the uterus (hysterectomy) and ovaries and fallopian tubes is a common treatment. If the cancer is at an early stage and has not spread, then surgery alone can be curative.

If the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms - for example, to relieve a blockage of the bowel or urinary tract which has been caused by the spread of the cancer.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which kills cancer cells or stops cancer cells from multiplying. Radiotherapy alone can be curative for early-stage endometrial cancer and may be an alternative to surgery. In some cases radiotherapy may be advised in addition to surgery.

Even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have developed in other parts of the body and are causing pain.

Chemotherapy

Chemotherapy is a treatment of cancer using anti-cancer drugs. They kill cancer cells, or stop them from multiplying. Chemotherapy is not a standard treatment for endometrial cancer but may be given in certain situations (usually in addition to radiotherapy or surgery).

Hormonal treatments

Treatment with progesterone is used in some types of endometrial cancer. It is generally not used in the initial treatments, but may be considered if the cancer spreads or comes back after those treatments.

What is the outlook (prognosis)?

There is a good chance of a cure if endometrial cancer is diagnosed and treated when the disease is at an early stage. This is when the cancer is confined to the uterus and has not spread. When the cancer has already spread, a cure is less likely but still possible. Even if a cure is not possible, treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer are likely to respond to treatment.


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